APPLICATION FOR MEMBERSHIP OF ASSOCIATION

ProLife Media Inc.

I, __________________________ of ______________________________

Hereby apply to become a member of the above named association. In the event of my admission as a member, I agree to be bound by the rules of the association for the time being in force.

Ph. No. Email:

_____________________

(Signature of Applicant).

Date: / /

I, __________________________ a member of the association, nominate the applicant, for membership of the association.

_____________________

(Signature of Nominator)

Date: / /

I,____________________________ a member of the association second the nomination of the applicant, for membership of the association.

_______________________

(Signature of the Seconder)

Date: / /

ProLife Media Inc.

1/14 Harty Street,

Coorparoo,

Brisbane, Qld., 4151,

Ph: 07 3847 2771;

Fax: 07 3847 3682;

Email: bob@prolifemedia.info

www.ProLifeMedia.info